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๐Ÿ‘ What if IOP rises again after trabeculectomy?

Although trabeculectomy usually controls IOP well in early stages,
bleb fibrosis or adhesion may cause IOP elevation later.
โžก Post-op management becomes crucial.


๐Ÿ’ง 1. Digital Massage

  • Indicated if IOP > 12 mmHg in early phase
  • Gently press the lower eyelid with the index finger for 10 seconds
  • Stimulates aqueous flow through bleb
  • Alternate: CTM (Carlo Traverso Maneuver)
    • Uses a cotton swab to press over the scleral flap at slit lamp


๐Ÿชก 2. Needle Revision (NR)

  • Uses a 26G needle to physically break adhesions under the conjunctiva
  • Expands the bleb space and restores outflow
  • Often combined with 5-FU injections to suppress fibrosis

โœ… High-risk cases: 1–2 injections per day starting day 1–2
โœ… Low-risk: every 2–3 days as needed


โœ… Summary

  • Surgery is not the end — it may require ongoing management
  • Digital massage & needle revision can restore failed blebs
  • Persistent high IOP → resume drops or consider repeat glaucoma surgery
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ยซ   2025/06   ยป
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